� The pearl of theIndian ocean

� Trails blazed� Challenges� Response - NCMH

2001 – 18.7 million soulsPop density – 299 / sq.km.85% rural(DS 94)Dependency 54(DS 94)Literacy 90.1(94)Per capita GNP US$ 856(2000)

Source - Annual Health Bulletin 2001Source - Annual Health Bulletin 2001

� Health unit 1926� Alma Ata 1978� Essential drugs list

1958 (WHO - 1977� GFATM

� Health unit 1926� Alma Ata 1978� Essential drugs list

1958 (WHO - 1977� GFATM

Triple burden ofdiseaseCommunicable tonon communicablediseasesDiseases ofcommunication

Triple burden ofdiseaseCommunicable tonon communicablediseasesDiseases ofcommunication

High cost ofmaintenance of existingfacilitiesPressure to expandservices / facilitiesPressure to keepabreast of technologicaladvancesDemand for all servicesat door step

0

0.5

1

1.5

2

2.5

1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000

Year

% S

hare

of G

DP

MOH Health Share o f GDP Nominal (R+C) Exp .

0.00

1.00

2.00

3.00

4.00

5.00

6.00

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

Y e a rHealth Share o f No minal GDP Ed ucat io n Share o f No minal GDPDefense Share o f No minal GDP

� Development of Health Finance Policyfor Equity, Efficiency andSustainability

� Strengthening of the Health FinancialManagement System

� Development of Health Finance Policyfor Equity, Efficiency andSustainability

� Strengthening of the Health FinancialManagement System

� Objective:To improve the equilibrium among equity,efficiency and sustainability of Health Finance

� Development of a health financial policy for national,provincial and district levels

� Development of a plan to reorient procedures andformats towards performance based planning andbudgeting

� Cost effectiveness studies…..� Community involvement ……� More Autonomy …….

� Objective:To improve the equilibrium among equity,efficiency and sustainability of Health Finance

� Development of a health financial policy for national,provincial and district levels

� Development of a plan to reorient procedures andformats towards performance based planning andbudgeting

� Cost effectiveness studies…..� Community involvement ……� More Autonomy …….

� Objective: To improve transparency andaccountability of the health system

� Strengthening and reorganizing the DDGFinance Office and DDG (Planning) forhealth service delivery and inter-sectoralhealth issues within the context of healtheconomic reality and with total accountability

� Strengthening and reorganizing the financialsystem and capacity of the PDHS Office

� Strengthening and reorganizing the DPDHSOffice

� Objective: To improve transparency andaccountability of the health system

� Strengthening and reorganizing the DDGFinance Office and DDG (Planning) forhealth service delivery and inter-sectoralhealth issues within the context of healtheconomic reality and with total accountability

� Strengthening and reorganizing the financialsystem and capacity of the PDHS Office

� Strengthening and reorganizing the DPDHSOffice

NationalNationalCommission onCommission on

�June 2002 - A Sri Lanka delegationparticipated at the Consultation onNational responses to the CMH Report

� Aug. 2002- National Health Councildecision to set up the National Commission

on Macroeconomics & Health

� Nov. 2002 - Appointment of the NCMH

�June 2002 - A Sri Lanka delegationparticipated at the Consultation onNational responses to the CMH Report

� Aug. 2002- National Health Councildecision to set up the National Commission

on Macroeconomics & Health

� Nov. 2002 - Appointment of the NCMH

1. To advise the Government and the Ministerof Health on all broad policy issues, policy

options and directions in relation to investmentsin health, both in the public and private sectors

so that health could make an optimalcontribution to development of the country.

2. To recommend new approaches and strategiesfor scaling up health interventions, particularly

those aimed at the poor, and increasing theinvestments in health for human development.

1. 1. To advise the Government and the MinisterTo advise the Government and the Ministerof Health on all broad policy issues, policyof Health on all broad policy issues, policy

options and directions in relation to investmentsoptions and directions in relation to investmentsin health, both in the public and private sectorsin health, both in the public and private sectors

so that health could make an optimalso that health could make an optimalcontribution to development of the country.contribution to development of the country.

2. To recommend new approaches and strategies2. To recommend new approaches and strategiesfor scaling up health interventions, particularlyfor scaling up health interventions, particularly

those aimed at the poor, and increasing thethose aimed at the poor, and increasing theinvestments in health for human development.investments in health for human development.

Contd….>

3. 3. To commission appropriate studies, inTo commission appropriate studies, indifferent aspects of macroeconomics anddifferent aspects of macroeconomics andhealth that will support the work of thehealth that will support the work of the

Commission.Commission.

4. 4. To recommend modalities for mobilizingTo recommend modalities for mobilizingincreased external resources for healthincreased external resources for health

development and to advise on broad policiesdevelopment and to advise on broad policiesand strategies for their optimal utilization.and strategies for their optimal utilization.

5. To advise the Minister of Health on all5. To advise the Minister of Health on allaspects related to economics and health foraspects related to economics and health for

overall health and human development in Srioverall health and human development in SriLanka.Lanka.

Contd..

Co-ChairmanHon.Minister of Health

Hon.Dep.Minister of Finance

Co-ChairmanHon.Minister of Health

Hon.Dep.Minister of Finance

NCMHNCMH

Planning CommitteePlanning Committee

SecretariatSecretariat

WG1Budgeting Issues

WG1Budgeting Issues

WG2Financing Issues

WG2Financing Issues

�Advocacy for healthinputs

�MDGs, Vision 2020,�PRSP, Master plan�Commitment by

Finance to increaseresources by 0.1%GDP annually

�Outcome of two complementary activities

�JICA assisted HMP development 2002,2003

�PHRD activity 2000 & 2002,2003

�Strategic Framework for MoH developed inApril 2003

�Outcome of two complementary activities

�JICA assisted HMP development 2002,2003

�PHRD activity 2000 & 2002,2003

�Strategic Framework for MoH developed inApril 2003

Improve Health Services Delivery and Health Actions

Strengthen Stewardship

& Management

Functions

Improve Human

Resource Development

& Management

Improve Health Financing,Resource Allocation

and Utilization

Strengthen individual, household and community actions for health

povertyreductionpoverty

reduction

health

� Master plan – SWAP� Implicit commitment� WB US $ 50 mlns� Performance based

budget – resources topoor

� Rehabilitation NE� Social marketing –

individual’s role inhealth,

� Family & societysupport

o Advocacy – privatesector

o Studieso Review of cost studieso Evaluation of taxation

and fiscal intensiveso Financing of provincial

health service

o Advocacy – privatesector

o Studieso Review of cost studieso Evaluation of taxation

and fiscal intensiveso Financing of provincial

health service

� calling for expressions ofinterests in undertakingMacroeconomics andHealth studies (34 /16 s-listed)

� seminar on policy issuesin health financing

� web site� TOR for working group

on financing